PFO closure consideration for refractory hypoxia and secondary prevention of recurrent arterial thromboembolism

Abstract

Acute arterial and deep venous thrombosis presenting simultaneously are uncommon medical emergencies, usually secondary to an underlying cause. We present a 64-year-old woman with concurrent bilateral pulmonary embolisms and acute thrombotic occlusion of the right brachial artery. Her work-up revealed a large patent foramen ovale (PFO), with a right to left intracardiac shunt and bilateral lower extremity deep venous thrombosis. The patient was unable to be weaned off mechanical ventilation due to her refractory hypoxia. However, after closure of the PFO the patient’s oxygenation improved. This case demonstrates the potential beneficial role of PFO closure in a hypoxic patient with a right to left intracardiac shunt. In addition, closure of the PFO may provide secondary prevention of paradoxical systemic thromboembolism.